HomeMy WebLinkAboutPermit Sidewalk 1994-11-15
225 NORTf.I FIFTf.I STREET
SPRINGFIELD, OREGON <:11411
ENGINEERING DIVISION
OR'ICE NO. 126-3153
INSPECTION LINE, 126-316<:1
RESIDENTIAL - COl'1MERCIAL
-. SIDEWALK I CURBCUT .
APPLICATIoN I PERMIT
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IiI':lO
JOB ADDRE$S. i/.-O :2 ~/ Ci / J (, ;' E I::t3
ASSESSORS MAP NO'* i 7 -0 3 - 2. 7 - 4/
!J/PST 4/VIAJ4LT
TAX LOT NO~ '* 10 (
RECEIPT NO, 0 (';"4,4-
CASH
SUBDIVISION,
Cf.lECK
</'
/-lAeSA
ADDRESS, ,~(jO W, =t-a i if vi p,u)
STATE, 012 E ZIP, Q74-7'7
WORK DEecRIPTION.
I SIDEWALK, / CURB SIDE ....::::::
CURB-CUT, RESIDENTIAL ~
SECOND DRIVEWAY (SEE TRAcrlC )
R!:QlJIRES APPLICATION FOR A SECOND DRlVEWAn'T-4.1.)
OR A COUNTY I.PPt.ICATION FOR FACILITY PERMIT (C ':l8-2"3)
IF IN Tl-1E U.G.s.
OUNER,
CITY, .<:::/J+ (d. ,
1 -
Pf.lONE NO.
*
Cf.lECKED FOR DELINQJENCIES =:::... I
SETBACK
CO:-r.-IERICAL _
DATE OF APPLICATION
11//'-1-191
SIGNED,
~T~
'0s::.te..4-
DATEI
WORK TO BE PEI"if'v"" It:D BY.
CONTRACTOR* ~A-t-OtJ
ADDRESS :lq~qq- R
OUNER
~ CONTRACTOR
REC.ISTRATION NO.* (J.?';;:;7! EXPIRES, 3b.i/ 9,<)
Evoene ()k!E 97f./O;J:....ONE, '4./-0otf3..
---, ,
CnV\~+ I NG .
A i..t;oo v- ~Qd
i"'~' .. -" .UR!: FOR IN&FECTION REQUEST.
CALL 1,6-316<:1 (RECORDER) STATE YOUR CITY DESIC.~TED JOB NLJ:"'19ER J09 ADDRESS,TYPE OF
INSPECTION REQlJE5TED A'ID lLI-IEN YOU WILL BE READY FOR IN5pECTION, CONTRACTORS OR OUNERS NAME A'ID
Pf.IONE NUM9ER REQUEST5 RECEIVED B"rvr= 1,"" AM WILL BE MADE Tf.lE SA'"1E DAY, REQJEST5 AFTER 1,00
AM WILL 9E MADE Tf.lE NEXT ~INC. DAY
* SEE BOOK
EXISTING BUILDINC. PERMIT NO. ( IF APPLICABLE)
YOUR CITY DESIC.NATED J09 NO. Isf q 4- 115"'2....
REQUIRED INSR:CTIONS
~ SIDEWALK I DRIVEWAY
FOR ALL CONCRETE pAVINC. WITl-IlN
Tl-IE STREET RIC.HT OF WAY, TO BE
MADE AFTER ALL EXCAVATINC.
15 COMPLETE AND FORM WO!<l<
AND SU9-BASE MATERIAL IS
IN Pl.ACE
D
CURB I AF'PROACl-I APRON,
A/-,ER FORM5 ARE ERECTED
BUT PRIOR TO POURING
CONCRETE.
FEES. SIDEWALKS CURB-CUT WALK x'
.10"00 . .0.15/LF. ( X ) //7 .10.00 . ~.1:;/LF. ( X ) / ""
OF WALK
COMMERICAL DRIVEWAYS SHALL l X' I.
l-IAVE :.' TO 8' FLAIR5
~ 27,'5"5" ;3'- 0" 5T A"'I.DAR:D " .,
TOTAL R:RMIT FEE.
1 rlA-VE CAR=-nJLL.,... EX.4"1INED TI-JE COMPLETED APPLICATION FOR FE~IT, ":"\lD DO l-lER,EBY CERiIF'T" i\-ol"'-T ALL
IN"'rORMATION l-IEREON IS TFaJE A"D CORRECT, A'lD I FURTHER CERTIFY Tl-IAT A'iY -"'iD ALL WOR< PERFORMED
Sl-IALL BE DONE IN ACCORDANCE WITH .THE ORDINA'iCES OF Tl-IE CiTY OF SpRINC::FIELD AND THE LAWS OF Tl-IE
5TATE OF OREGON PERTAINING TO Tl-IE ~ DESCRIBED l-IEREN. A'ID Tl-IAT NO OCCUPA'iCY WILL BE MADE
OF A'iY 5TRUCTURE WITHOUT pE~1551ON OF Tl-IE BUILDINc. DIYISION. I FURTHER CERTIFY 7HAT ONLY CONTRACTORS
AND EMPl.OYEES WHO ARE IN COMPLlA'ICE WITl-I ORe. 1"1-,*,:. WILL BE U5ED ON THIS PROJECT.
I( 1/</)CfP-
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DATE
51c.NED